374604422-10-8-2026-08-AS-LTEZ-DYPUB2-20261009152538

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604422
Report Date: 10/08/2026
Date Signed: 10/08/2026 03:27:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/02/2021 and conducted by Evaluator Iby Strong

PUBLIC

COMPLAINT CONTROL NUMBER: 08-AS-20211102121858

FACILITY NAME:	LA JOLLA CASA PACIFICA		FACILITY NUMBER:	374604422
ADMINISTRATOR:	FERNANDEZ, JENNIFER		FACILITY TYPE:	740
ADDRESS:	5468 PACIFICA DR		TELEPHONE:	(858) 775-6935
CITY:	LA JOLLA	STATE: CA	ZIP CODE:	92037
CAPACITY:	0	CENSUS: 0	DATE:	10/08/2026
		UNANNOUNCED	TIME BEGAN:	03:22 PM
MET WITH:	Report Mailed to Licensee via USPS Certified Mail		TIME COMPLETED:	03:23 PM

ALLEGATION(S):

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Staff did not administer medications as prescribed.
-Staff did not issue resident a refund.
-Facility failed to communicate with resident's representative promptly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong sent this report to the former licensee's last known mailing address via USPS certified mail to deliver the investigation findings for the above-mentioned allegations. This facility ceased operations on February 20, 2026.

In November of 2021, Community Care Licensing (CCL) received a complaint alleging staff did not administer medication as prescribed, staff did not issue resident a refund and facility failed to communicate with resident’s representative promptly. During the investigation the Department attempted to collect records. Interview conducted did not reveal any information to corroborate any of the allegations. There were no records available to support the allegations.

Based available information there was not a preponderance of evidence to prove the alleged violations occurred, therefore the allegations are unsubstantiated. A copy of this report was mailed to Licensee via USPS Certified Mail.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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